<!DOCTYPE html>
<html lang="zh" xmlns:th="http://www.thymeleaf.org" >
<head>
    <th:block th:include="include :: header('新增【请填写功能名称】')" />
</head>
<body class="white-bg">
    <div class="wrapper wrapper-content animated fadeInRight ibox-content">

        <form class="form-horizontal m" id="form-owner-add">
            <div class="form-group">
                <div class="col-sm-8 mes_ban">
                    <img th:src="@{img/banner copy.png}"/>
                </div>
            </div>
            <div class="form-group">
                <div class="col-sm-8">
                    <p class="notic_p1">小区公告：疫情防控，请如实填写信息</p>
                    <p class="notic_p2">
                        个人信息登记<span>【五号院小区】</span>
                    </p>
                </div>
            </div>
            <div class="form-group">
                <div class="col-sm-8">
                    <input name="comId"  class="form-control" type="hidden">
                </div>
            </div>
            <div class="form-group">
                <label class="col-sm-3 control-label">扫码人姓名：</label>
                <div class="col-sm-4">
                    <input name="name"   maxlength="12" class="form-control" type="text">
                </div>
            </div>
            <div class="form-group">
                <label class="col-sm-3 control-label">手机号：</label>
                <div class="col-sm-4">
                    <input name="phone"  max="11" class="form-control" type="text">
                </div>
            </div>
            <div class="form-group">
                <label class="col-sm-3 control-label">身份证号：</label>
                <div class="col-sm-8">
                    <input name="pinCode" class="form-control"  maxlength="24" type="text">
                </div>
            </div>
            <div class="form-group">
                <label class="col-sm-3 control-label">用户类型：</label>
                <div class="col-sm-4">
                    <select name="type" class="form-control m-b" required>
                        <option value="1">业主</option>
                        <option value="2">家属</option>
                        <option value="3">租客</option>
                    </select>
              </div>
            </div>
            <div class="form-group">
                <label class="col-sm-3 control-label">楼号：</label>
                <div class="col-sm-4">
                    <select name="buildCode" class="form-control m-b" required>
                        <option value="A">A</option>
                        <option value="B">B</option>
                        <option value="C">C</option>
                        <option value="D">D</option>
                        <option value="1">1号楼</option>
                        <option value="2">2号楼</option>
                        <option value="3">3号楼</option>
                        <option value="4">4号楼</option>
                        <option value="5">5号楼</option>
                        <option value="6">6号楼</option>
                        <option value="7">7号楼</option>
                        <option value="8">8号楼</option>
                    </select>
                </div>
            </div>
            <div class="form-group">
                <label class="col-sm-3 control-label">单元：</label>
                <div class="col-sm-4">
                    <select name="unit" class="form-control m-b" required>
                        <option value="1">1单元</option>
                        <option value="2">2单元</option>
                        <option value="3">3单元</option>
                        <option value="4">4单元</option>
                        <option value="5">5单元</option>
                        <option value="6">6单元</option>
                        <option value="7">7单元</option>
                        <option value="8">8单元</option>
                    </select>
                </div>
            </div>
            <div class="form-group">
                <label class="col-sm-3 control-label">房间号：</label>
                <div class="col-sm-4">
                    <input name="roomNo" class="form-control" type="text">
                </div>
            </div>
            <div class="form-group">
                <label class="col-sm-2 control-label">是否到过疫情严重地区：</label>
                <div class="col-sm-10">

                        <label class="checkbox-inline">
                            <input type="radio" checked="" value="1" id="optionsRadios1" name="ncpAreaPass">是</label>


                        <label class="checkbox-inline">
                            <input type="radio" value="0" id="optionsRadios2" name="ncpAreaPass">否</label>

                </div>
            </div>
            <div class="form-group">
                <label class="col-sm-2 control-label">经过新冠肺炎地区：</label>

                    <div class="col-sm-10">
                        <label class="checkbox-inline">
                            <input type="checkbox" value="湖北" id="inlineCheckbox1">湖北</label>
                        <label class="checkbox-inline">
                            <input type="checkbox" value="武汉" id="inlineCheckbox2">武汉</label>
                        <label class="checkbox-inline">
                            <input type="checkbox" value="浙江" id="inlineCheckbox3">浙江</label>

                        <label class="checkbox-inline">
                            <label>其他地区</label>
                            <input name="passNcpArea" class="form-control" type="text"></label>

                    </div>


                    <!--<input name="passNcpArea" class="form-control" type="text">-->
            </div>
            <div class="form-group">
                <label class="col-sm-2 control-label">是否接触过新冠肺炎病人：</label>
                <div class="col-sm-10">

                        <label class="checkbox-inline">
                            <input type="radio" checked="" value="1" id="contactNcpPatient1" name="contactNcpPatient">是</label>

                        <label class="checkbox-inline">
                            <input type="radio" value="0" id="contactNcpPatient2" name="contactNcpPatient">否</label>

                </div>
            </div>
            <div class="form-group">
                <label class="col-sm-2 control-label">是否不适：</label>
                <div class="col-sm-10">

                        <label class="checkbox-inline">
                            <input type="radio" checked="" value="1" id="illness1" name="illness">是</label>


                        <label class="checkbox-inline">
                            <input type="radio" value="0" id="illness2" name="illness">否</label>

                </div>
            </div>
            <div class="form-group">
                <label class="col-sm-2 control-label">症状(格式：发烧,胸闷,咳嗽,乏力)：</label>
                <div class="col-sm-10">
                    <label class="checkbox-inline">
                        <input type="checkbox" value="发烧" id="symptom1">发烧</label>
                    <label class="checkbox-inline">
                        <input type="checkbox" value="胸闷" id="symptom2">胸闷</label>
                    <label class="checkbox-inline">
                        <input type="checkbox" value="咳嗽" id="symptom3">咳嗽</label>
                    <label class="checkbox-inline">
                        <input type="checkbox" value="乏力" id="symptom4">乏力</label>
                    <label class="checkbox-inline">
                        <label>其他症状</label>
                        <input name="symptom" class="form-control" type="text"></label>

                </div>
            </div>
        </form>
    </div>
    <th:block th:include="include :: footer" />
    <script type="text/javascript">
        var prefix = ctx + "system/owner"
        $("#form-owner-add").validate({
            focusCleanup: true
        });

        function submitHandler() {
            if ($.validate.form()) {
                $.operate.save(prefix + "/add", $('#form-owner-add').serialize());
            }
        }
    </script>
</body>
</html>
